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July IVF – CD21

I slept almost all of Sunday. I honestly can’t remember sleeping so much since I was a teenager. Nearly three weeks of injections, and the restlessness that comes from being home alone, had clearly taken their toll.

So when Monday morning rolled around, I was feeling mostly like a human being again and keen to get back to the clinic and see the doctor. I got up bright and early, got myself ready, then went into the bedroom to check on Doug.

“Up you get, darling. We need to leave in twenty minutes.” I said, shaking him awake.

Doug moaned something unintelligible, threw a pillow over his head and rolled over. After much cajoling, I finally got him up out of bed. But instead of hopping into the shower, he went downstairs to make himself some toast.

“What are you doing right now?!” I shrieked, following him into the kitchen. ” Are you trying to enrage me? I’ve been on hormone shots for 3 weeks! My temper isn’t exactly under control.”

“I’m a growing boy,” he shrugged. “I’ve got to eat!”

“You’ve got to shower.” I argued.

“Eat.” said Doug.

“Shower.” said I.

Twenty tense minutes later, after reaching a compromise, we were finally in the car with two pieces of honey toast for Doug to eat on the way to the hospital. We arrived right on time (luckily for him) and took our seat in the waiting room.

My name was called soon afterwards, and for the second time in 48 hours I was making my way towards the small room behind Doctor B’s office where I was to be scanned. Except this time, there was hope. And thankfully the fancy shmancy silver ultrasound machine was back.

“All right let’s take a look,” Doctor B said, starting the scan.

Almost straight away, she was showing me my left ovary, where I could see one large follicle which now measured 15.5mm. My endometrium was also perfect looking – a 9.7 triple, whatever that means…

“This is quite ironic.” she admitted. “Miss Sadie you’ve never ovulated in your life. So we’ve given you FSH injections to try and get many eggs for IVF, and instead your body seems to be perfectly mimicking a natural cycle. See how those other follicles have all shrunk down now and you’re left with just one? This is how it’s supposed to happen.”

I got dressed and we all went into the doctor’s office to have a chat about what the plan would be going forward. I felt sort of giddy with nerves and excitement.

Obviously the IVF cycle was over now, because there would be no egg pick up. Doctor B offiically converted our cycle to ovulation induction and instructed us to “begin coitus.” I tried not to giggle at her use of the word. There are literally dozens of words she could have chosen that mean the same thing, and are also more widely used. Coitus sounds like a foot fungus.

She also told us we would have to pay for all of the medication that we’ve used during the cycle. All the FSH and antagonist injections are wrapped up into the heavily government subsidized cost of IVF, but since we were no longer doing IVF we could no longer claim the costs that way. Luckily given our circumstances (medical infertility, no children) Doctor B was able to ring through and ascertain a PBS number for us.

The PBS (Pharmaceutical Benefits Scheme) is an Australia Government system that subsidises the cost of prescription medicines. I’m sure there are equivalents in most countries. Patients are only able to get certain medications discounted on the schedule if they have an acceptable reason. Which was the case for us.

“So are we all clear on this?” Doctor B asked.

“No,” I admitted. “I’m not clear on anything. We’re going to do this the regular way? Like regular, fertile people?”

“Yes.” Doctor B confirmed.

“Well you’re going to need to walk me through this,” I said sheepishly. “Because I don’t think I know how the regular way works.”

For some reason, Doctor B found that idea very funny, but she kindly pulled out some paperwork and walked me through the process step by step.

Step one – that evening, we were able to have intercourse. This step wasn’t mandatory, as my follicle was still only 15.5mm and we need it to be 18mm for it to be considered pregnancy viable (though anything above 14mm is technically mature). By having sex that night, we would basically ensure some sperm was sitting there ready to go when I eventually did ovulate. The risk, however, was knocking the egg out of the follicle during sex. Given I’ve been stimming for 3 weeks, and I’m now off the orgalutran which prevents early ovulation, there was a small possibility this would happen. So Monday night sex was up to us.

Step two- Tuesday morning I would get a blood test to check my LH, progesterone and estrogren levels. Pretty straight forward. No sex.

Step three – Wednesday at 8.45am I would go back to see Doctor B. She would scan me and check if I’ve ovulated. If I haven’t (which is what we hope will be the case), then the follicle should be pretty close to 18mm so I can be artificially triggered for ovulation. Sex on the Wednesday night is a definite, and then again on the Friday – which is the day the egg should leave the ovary.

And then, we get to suffer the two week wait like regular people. Except we won’t be able to test early, because Doctor B suspects she will need to give me a few shots of pregnyl (a hcG hormone) throughout the fortnight to keep my levels steady.

In two weeks, I’ll either be pregnant or get my period (that part I already knew……). The good news being, if my period arrives Doctor B is happy enough with my health that I can start FSH injections again immediately at a higher dose and try to actually get to egg pick up this time. So in two weeks I’ll either be pregnant, or starting a new cycle of IVF. Win, win situation!

Here’s where I explain to you what it’s actually like to be on the slippery slope from infertility to madness. When you’re infertile you start to hear things selectively, even though you really shouldn’t. Even though you know you’re only hurting yourself.

“I want to be clear with you,” Doctor B said. “The chances of this working are extremely unlikely.”

There’s a chance this will work! I thought, squeezing Doug’s hand.

“You have so many factors causing infertility, and let’s not forget Doug has a minor male factor as well.” Doctor B continued. “That’s not to say it won’t work, I just need you to understand the odds.”

There’s nothing to say this won’t work! I thought happily, whilst nodding my head to let her know I understood.

“Ok you two,” she said, motioning to Doug and I. “I’ll see you on Wednesday. Good luck.”

Good luck! I grinned, getting up and heading for the door. She’s wishing us luck on our pregnancy.

As usual, by the time we made it to our car in the hospital car park, reality had re-entered my brain and I was feeling depressed and anxious about the whole situation.

“Because this has a zero point zero zero zero one percent chance of working and I don’t want anyone putting an idea in my head that our chances are any better than that.” I explained.

Too late! said the voice in my head, even though I tried my hardest to suppress it.

We drove to the pharmacy next. We needed to replenish the stocks of the clinic’s FSH we had used, but patients are not able to physically handle the drugs. So the plan was to pay for the medication and have the pharmacy ship them to Doctor B’s clinic. On the way there a google search told me the drugs we had used would cost approximately $2650. I nearly passed out from shock.

Of course we are fully prepared to spend money in our quest to have a child. We’d factored in a cost of $7000 for this cycle of IVF (because of the added cost of MRIs and other non-routine testing that happened for us this time around). But $7000 for IVF seemed acceptable, because IVF gives us a hugely increased chance of achieving our baby goal. Meanwhile, $2650 on a stab in the dark, one in a million possibility was asking a lot.

I was shaking when I handed the medication script over to the pharmacist, and waited nervously while he called to order in the vials we required.

“Ok that’ll be $36.10.” he said.

“………….sorry?” I asked, frowning.

“36 dollars and 10 cents.” he said, slower this time.

“There’s a mistake.” I said quickly. “I’m ordering 2100iu of Puregon.”

“Yes.” he said, and I could see he was trying to make up his mind if I was sane or not. “That will be $36.10.”

“But…”

Before I could argue any further, Doug was handing over a $50 note to pay for the drugs.

I wanted to do a happy dance in the pharmacy. I friggen love the PBS. I love Australia. There’s no way we could afford to go through these fertility treatments in many (if any) other countries. I’m so extremely grateful for that.

Next up on the agenda was work. I had so much to do at work, and a shortened work day wasn’t going to make my tasks any easier to accomplish.

But that morning I spent way too much of my brain capacity stressing about whether or not we should have sex in the evening and risk early ovulation, or abstain and then risk missing ovulation entirely. Realising I wasn’t getting any of my work done, I went outside where no one could hear me and phoned my mother to ask for advice. Um, is it weird that I feel most comfortable talking over these things with my mother??

“Turkey baster.” my mother said.

“What? Mum, no.” I spluttered.

“Turkey. Baster.” she said again insistently. “You’ll get the sperm up there without bumping anything.”

And then I thought about it more, and I realised she was right. Sure it wasn’t ideal. It wasn’t romantic. It didn’t fit with the notion I have in my head of couples making love and creating life. But what else about my life was ideal and romantic? The constant injections? The regular transvaginal ultrasounds? The cramping, acne, mood swings, bloating and bruising?

Plus, we could always try for the old fashioned romance on Wednesday night if the scan that morning went well.

With much trepidation, I called Doug and divulged my plan. Surprisingly, he agreed.

“Whatever it takes, darling.” he said. “We will do whatever it takes.”